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CMS has finalized new rules unveiled last year that will expand telehealth access and reimbursement for the growing number of Americans in Medicare Advantage plans – and their doctors.

By Eric Wicklund

April 08, 2019 – The Centers for Medicare & Medicaid Services has finalized its plan to expand telehealth access and coverage in Medicare Advantage plans.       

In a Friday afternoon announcement, CMS said new rules will eliminate geographical restrictions on telehealth access and telemedicine services in MA plans by 2020, enabling those in urban areas to use connected health technology. The changes will also give MA members more locations to access care, including their own home.

“Today’s policies represent a historic step in bringing innovative technology to Medicare beneficiaries,” CMS Administrator Seema Verma said in a press release. “With these new telehealth benefits, Medicare Advantage enrollees will be able to access the latest technology and have greater access to telehealth. By providing greater flexibility to Medicare Advantage plans, beneficiaries can receive more benefits, at lower costs and better quality.”

The increase in connected care coverage will benefit an ever-increasing population of Americans, as well as the healthcare providers treating them. According to the Kaiser Family Foundation, some 20.4 million people, or 34 percent of the Medicare population, were enrolled in MA plans in 2018. And with an annual growth rate of about 8 percent, it is expected that the MA population will rise to about 42 percent in a decade.

The new rules come out of the Bipartisan Budget Act of 2018, which aims to boost telehealth and telemedicine use in MA plans by relaxing restrictions currently in places for traditional Medicaid plans. They were unveiled in October 2018, with public comment running through the end of the year.

Under current guidelines, Medicare members can access limited telehealth and telemedicine services if they live in federally designated rural areas. CMS loosed the reins a bit this year, including in the 2019 Medicare Physician Fee Schedule and Quality Payment Program some reimbursement for remote patient monitoring and virtual check-ins.

“Historically, Medicare Advantage plans have been able to offer more telehealth services, compared to Original Medicare, as part of their supplemental benefits,” CMS said in last week’s announcement, now posted in the Federal Register. “But with the final rule, it will be more likely that plans will offer the additional telehealth benefits outside of supplemental benefits, expanding patients’ access to telehealth services from more providers and in more parts of the country than before, whether they live in rural or urban areas.”

The announcement is the latest in a busy few months of initiatives aimed at boosting access to and coverage for telehealth and telemedicine.

In January, CMS updated its Value-Based Insurance Design (VBID) model of care, introduced in 2017 and overseen by CMS’ Center for Medicare and Medicaid Innovation Center (CMMI), to give providers treating people on MA plans more leeway in using telehealth in pace of in-person checkups.

“Expanding choices for patients, aligning incentives, and providing new flexibility for insurers in Medicare Advantage and Medicare Part D will deliver better value from these programs,” Health and Human Services Secretary Alex Azar said in a press release.  “The models being announced today create new incentives for plans, patients, and providers to choose drugs with lower list prices, and new ways to meet the unique healthcare needs of specific populations, prevent disease, and expand the use of telehealth.  Today’s announcement draws on successes we have already seen in Medicare and advances our priority of using HHS programs to build a value-driven healthcare system.”

The agency is also experimenting with a program that would reimburse providers using Mobile Integrated Health (MIH) services to reduce unnecessary ED visits. And Congress is getting into the act with the pending reintroduction of the Reducing Unnecessary Senior Hospitalizations (RUSH) Act, which aims to give skilled nursing facilities (SNFs) more incentives to use telehealth and telemedicine.

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